Translators and mediators: bilingual young people's accounts of their interpreting work in health care

The interpreting work bilingual young people do in health care settings has largely been seen as a social problem, indicating deficiencies either in parents' language skills or in the provision of professional interpreting services. Little research has addressed this contribution young people make to health care work from their perspectives. This study explored the accounts of bilingual young people from four linguistic groups in London, including those from established minority groups and those more recently arrived. Young people reported extensive experience of interpreting in a number of settings, and identified a range of benefits to themselves and their families arising from their contributions, as well as some problems faced in achieving successful encounters. Focusing on young people's own accounts enabled their work to be conceptualised not as merely 'inappropriate and inadequate interpreting' but as a varied contribution to the informal economy of health care that ranged from simple translation to complex mediation between families, the wider community and the health care system.     

Victims and Perpetrators, Racism and Young People in Northern Ireland

This paper looks at the relationship between racist harassment and children and young people in Northern Ireland. It reviews the evidence from police records of cases where children and young people have been subjected to and victimised by such harassment, abuse and violence, and uses the same data to reveal the role of young people as perpetrators of racist harassment--both to young people and also towards adults from the minority ethnic communities. The material is drawn from a larger study on racist, homophobic and sectarian harassment, funded by the Office of Minister and Deputy First Minister, but this paper focuses on 152 of the 881 cases reported to the police between 1996 and 2001 in which children and young people were the victims of some form of violence or abuse. Worryingly, the research reveals that young people report a higher proportion of cases involving physical abuse than adults. The paper also looks at the prominent role that young people play in the racist harassment of members of minority ethnic communities. The police data suggest that young people are involved in more than 50% of cases reported to them. Having provided a basic analysis of the issues, the paper also reviews the main policy responses in relation to racism and children and young people, primarily through the education system, and concludes by offering some suggestions as to what is needed to develop an effective strategy to respond to this emergent problem for the immediate future.     

Health and social care needs in minority communities: an over‐problematized issue?

As far as Britain’s black and South Asian minority communities are concerned, the development of health and social care in the community is often perceived to be problematic. For some minority groups (or for some sections of particular communities) this view is justified. Firstly, significant numbers of people in minority ethnic communities are socially and economically disadvantaged and might lack the resources (income, satisfactory housing, access to transport, family support) to provide care to the level that is needed. Secondly, the planning and delivery of care services for people in minority communities can leave much to be desired. Among other problems, racism and institutional discrimination can result in services which neglect the needs of minority communities. However, the argument remains that to a degree the issue of community care in minority ethnic communities is an over‐problematized one. Are the problems faced by particular groups in the minority population experienced widely in every minority community? This paper examines the argument by focusing on the care of older people. It accepts that problems of racism in the planning and delivery of health and social services are serious and lead to limited access to, and under‐use of, social services by some. However, it is evident that some minority communities are in a much better position than others to meet the care needs of older people.     

“Care Just Changes Your Life”: Factors Impacting upon the Mental Health of Children and Young People with Experiences of Care in Northern Ireland

This paper represents one element of a research project carried out into the mental health needs of children and young people with experiences of care in Northern Ireland. Focusing exclusively on qualitative data collected from 51 young people in care and aftercare, it discusses in the first instance how the challenges and difficulties faced by young people can manifest themselves in feelings and behaviours that may exemplify poor mental well-being. In doing so it provides an understanding of mental health in the context of these young people's lives. Through offering a more detailed account of some of the specific issues that put these young people at increased risk, it highlights areas for further work and consideration as a means of protecting them against these risks. These include: dealing with experiences prior to care; easing and “normalising” the experience of living in care; and enhancing “safety nets” after care. A key objective of the research is to inform policy and practice through the accounts of children and young people. It is argued that more work needs to be done to find creative ways of enhancing the day-to-day experiences of young people while in care and when leaving care.     

Medicaid's impact on access to and utilization of health care services among racial and ethnic minority children

Conclusion Numerous studies throughout the last 30 years and the results presented here from theKaiser/Commonwealth Five State Low Income Survey support Medicaid's role in improving access to care for poor minority children. Since minority children are affected disproportionately by the unavailability of health insurance, Medicaid's role as a financing source is particularly important to these groups. It is also clear that reducing financial barriers will not eliminate completely the inequalities in health care utilization and disparities in health status across different racial and ethnic groups. As discussed above, despite Medicaid's influence, minority children still exhibit poorer quality of health. Thus, strategies for the next century should focus on ensuring that all barriers to care are removed. This will involve not only the guarantee of universal health care coverage for all children, but also the elimination of social, cultural, and behavioral barriers to optimum health and health care as well.     

Negotiating cultures: disclosure of HIV-positive status among people from minority ethnic communities in Sydney

Because of the multiple stigma attached to HIV/AIDS, disclosure of HIV-positive serostatus is a considerable social risk for those who disclose. While HIV/AIDS-related stigma affects all HIV-positive people, for people from minority cultures additional cultural factors may play a significant role in self-disclosure. This paper draws on data from semi-structured, in-depth interviews with HIV-positive people from minority cultures in Sydney. Disclosure decisions were influenced by gender, sexual orientation, as well as cultural background. Gay men drew on both collectivist and individualist notions of interdependence and self-reliance in different socio-cultural contexts. This enabled them to accommodate the imperative to maintain harmony with the family and meet their individual needs for support. Heterosexual men who had disclosed voluntarily or involuntarily experienced discrimination and avoidance, and interdependence with family and ethnic community was disrupted. Heterosexual women disclosed to no one outside the health care system and were anxious to avoid any disclosure in the future. For all participants, voluntary and involuntary disclosure caused potential and actual disruption of relationships with their families and ethnic communities. The paper concludes by arguing for an ecological perspective of health in which decisions are not located in rational decision making alone but in the broader context of family and community.     

Families' and healthcare professionals' perceptions of healthcare services for children and young people with medically unexplained symptoms: a narrative review of the literature

Children and young people frequently report physical complaints that have no observable physical pathology known as medically unexplained symptoms (MUS). Research suggests that MUS are associated with substantial physical and psychological impairments and may have a negative impact on children's and young people's functional status and well‐being in the long term. Due to the potentially complex needs of this group, children and young people with MUS may require timely access to suitable health and social care services to effectively manage symptoms and achieve their academic, social and personal potential. Families and professionals can offer important insights into the availability and appropriateness of current community and specialist health and social care services. This review is the first critical evaluation and synthesis of research that has examined families' and healthcare professionals' (HCP) perceptions of healthcare services for children and young people with MUS. A systematic search of electronic databases and manual searches of key journals and reference lists identified 17 papers from 15 studies for inclusion in the review. The review highlights the paucity of rigorously conducted research on this topic. Studies have been narrowly focused on the views of a homogeneous group of mothers and young people attending single centres. There has been some attempt to examine doctors' views, but the perceptions of children, fathers and health and social care professionals are absent or under‐represented, and multi‐site and longitudinal studies are lacking. Thematic analysis of the results from the included studies suggests that knowledge, communication, health beliefs and healthcare settings are factors that influence families' and HCPs' perceptions of services. Families report dissatisfaction with some HCPs' approach to managing MUS. The findings suggest that children and young people with MUS are at risk of receiving suboptimal care and support because there is insufficient research to inform high‐quality, evidence‐based practice.     

Promoting and protecting the health of children and young people

BACKGROUND: The health-related behaviours adopted by children and young people can have both immediate and long-term health effects. Health promotion interventions that target children and young people can lay the foundations of a healthy lifestyle that may be sustained into adulthood. This paper is based on a selective review of evidence relating to health promotion in childhood, carried out to support the external working group on the 'Healthy Child' module of the Children's National Service Framework. METHODS: This is a selective review of mainly secondary research. It focuses on injury prevention, support for parenting and the promotion of good mental health, and promoting a healthy diet and physical activity amongst children and young people. FINDINGS: In many areas, the quality of primary research into health promotion interventions aimed at children and young people is poor. Interventions are heterogeneous and not described in sufficient detail. Sample sizes tend to be small, and there are commonly problems of bias. Despite these difficulties, there is good evidence for a range of interventions, including (1) area road safety schemes; (2) combining a variety of approaches to the promotion of the use of safety equipment, including legislation and enforcement, loan/assisted purchase/giveaway schemes, education, fitting and maintenance of safety equipment; (3) school-based mental health promotion; (4) parenting support; (5) interventions that promote and facilitate 'lifestyle' activity for children, such as walking and cycling to school, and those that aim to reduce sedentary behaviours such as parent education to reduce the time children spend watching TV and using computers; and (6) controlling advertising of unhealthy food that is aimed at children. CONCLUSIONS: There are effective interventions to promote and protect the health of children and young people that require action across the five areas described in the Ottawa Charter. Health, social care and education services have a direct role in the delivery of many of these interventions and, in other areas, a role in collaborative work with other agencies, in lobbying for policy change and in raising the profile of child health promotion. Further research is needed using larger study populations, and closely defined interventions, both targeted and universal, in order to fill some of the current gaps in the evidence base for health promotion in children and young people.     

The Participation of Disabled Children and Young People: A Social Justice Perspective

There is an increasing expectation that children, young people and their parents should participate in decisions that affect them. This includes decisions about their health and social care and collective or public decisions about the way in which such services are designed, delivered and evaluated. Indeed this has become a policy priority across the United Kingdom. The participation of disabled children and young people, however, has been slow to develop in the United Kingdom and concerns have been expressed about progress in this area. Drawing on the results of an Economic and Social Research Council-funded, mixed-methods study, the aim of this article is to explore the participation of disabled children and young people through a social justice lens. Participants, recruited by purposeful sampling, included 18 disabled children and young people, 77 parents and 90 professionals from one health and social care trust in Northern Ireland. There were four phases of data collection: surveys to parents and professionals, parent interviews, interviews with children and young people using creative and participatory techniques, and a focus group with professionals. Results showed that for most disabled children and young people, decision-making was firmly grounded in a family-centred model. However, when children and young people were drawn into participatory processes by adults and recognised as partners in interactions with professionals, they wanted more say and were more confident about expressing their views. Choices, information and resources were at times limited and this had a key impact on participation and the lives of these children, young people and their parents. The article concludes by exploring implications for further research and practice. The need for a two-pronged, social justice approach is recommended as a mechanism to advance the participation agenda.     

Developing primary care services for young people

The Cornwall and Isles of Scilly Health Promotion Service and Cornwall Youth Service have been working in partnership to facilitate the planning and promotion of high quality attractive and relevant designated health services for young people. This partnership arose from a joint project in North Cornwall looking at unwanted teenage pregnancies. It involved research with young people about their perspective of health services in their area, and a theatre in education project with the Barbican Theatre working with primary health care teams to raise awareness about the issues relating to health care for young people. The team have presented their work at several conferences, it has won a NHS 50 National Award sponsored by Glaxo-Wellcome, and has attracted much interest locally and nationally from policy makers and practitioners. This paper describes how the team came together, the various stages in the development and execution of the project, the outcomes and recommendations     

A confirmatory factor analysis of the BASIS-32 in racial and ethnic samples

The present study performed confirmatory factor analysis across major racial and ethnic groups of the BASIS-32, a measure of functional status of persons receiving mental health treatment and suitable for routine assessment mental health care. The purpose was to perform a preliminary investigation of cross-cultural equivalence in a county-level mental health program in a major metropolitan area. The results indicated a factor structure similar to that reported in the literature, and they suggested acceptable levels of agreement in structure between racial and ethnic minority groups and whites. The study revealed little reason to believe that the BASIS-32 varied in underlying structure across racial and ethnic boundaries, although further research is indicated.     

Sexual discourses and strategies among minority ethnic youth in the Netherlands

This study explores the way minority ethnic youth in the Netherlands evaluate their sexual experiences, how they frame these experiences in different sexual discourses and how they deal with conflicts between different sexual discourses, both at home and in Dutch society. During 46 narrative interviews, Dutch young people (aged 12–22 years) from different minority ethnic communities shared their sexual histories and their dreams for the future relating to love and sexuality. Different sexual discourses can be identified in the language they used to describe their ideas and their experiences. Young people grow up with a variety of discourses but actively re-shape them according to circumstances and need. In many cases, young people experience a conflict between the discourses of the home and those that are prevalent more generally in Dutch society. Young people's ways of negotiating these contradictory discourses comprise four main strategies: (1) conforming to parents' values, (2) breaking up with parents, (3) leading a double life and (4) integrating competing discourses. By bringing together different sexual discourses and acknowledging diverse strategies, sexual health policies can become more effective in promoting sexual health for minority ethnic youth. Findings from the study add fuel to debate on understanding (sexual) agency among young people, exhibiting the social ‘embeddedness’ of individual agency.     

“I’ve changed so much within a year”: care leavers' perspectives on the aftercare planning process

ABSTRACT

Increasing the participation of children and young people in matters related to their care and aftercare is regarded as international best practice. While research demonstrates that children and young people benefit from involvement in care-related processes, participation continues to pose challenges for social work practitioners. Studies to date have tended to focus on in-care engagement and, consequently, relatively little is known about the experiences of young people as they age out of care, particularly in terms of their perceived involvement and engagement in the planning-to-leave care process. This paper examines young people’s experiences of the aftercare planning process in Ireland drawing on data from the first phase of a qualitative longitudinal study of young people leaving care. Sixteen participants were recruited at baseline and interviewed in-depth. The approach to interviewing was flexible and encouraged participants to talk about their experiences of care and the aftercare planning process. The findings indicate considerable diversity in how young people experience and attach meaning to the transition out of care. They also reveal complexities surrounding youth participation in the leaving care planning process and uncover a number of distinct facilitators and barriers to participation. Conclusions are drawn and the implications for practice are discussed.     

The buffering effects of ethnic density on experienced racism and health

Studies in the United Kingdom (UK) show a consistent inequality between the health of ethnic minorities and that of white people. This is exacerbated by the over-representation of ethnic minorities in deprived areas, which have been associated with poorer infant and child health, chronic disease, and high mortality rates. Ethnic density, defined as the proportion of ethnic minority residents in an area, is generally thought of in relation to the negative impacts of area effects on health. However, it can be considered in terms of social networks and supportive communities, possibly mitigating the detrimental impact of racism on the health of ethnic minority people. This study investigated the ethnic density effect and hypothesised that ethnic minority people who live in areas of high ethnic density would report decreased experienced racism and better health outcomes compared to their counterparts living in areas of low ethnic density. Multiple logistic regressions were conducted using data from the Fourth National Survey of Ethnic Minorities and the 1991 UK Census. Results showed a negative association between ethnic density and psychotic symptomatology, but no evidence of an association between ethnic density and general self-rated health. Findings confirm that the experience of racism is lower in places of higher ethnic density and indicate a tendency for a weaker association between racism and health as ethnic density increases.     

The burden of proof: The process of involving young people in research

Patient and public involvement in research includes non‐academics working with researchers, on activities from consultative tasks, to joint working, and on user‐led initiatives. Health and social care funding bodies require involvement in research projects. A current debate focuses on a perceived lack of empirical “proof” to demonstrate the impact of involvement upon the quality of research. It is also argued that the working relationships between researchers and those becoming involved need to be understood more fully. These areas are beginning to be reported upon but there are few studies of young people involved in health research. This study describes the experiences of adult academics and young people, working together on a large‐scale, UK health research programme. Using qualitative interview and focus group methods, the aim was to explore participants’ perceptions about the process and outcomes of their work together. The importance of cyclical, dynamic and flexible approaches is suggested. Enablers include having clear mechanisms for negotiation and facilitation, stakeholders having a vision of “the art of the possible,” and centrally, opportunities for face‐to‐face working. What is needed is a continuing discourse about the challenges and benefits of working with young people, as distinct from younger children and adults, understanding the value of this work, without young people having to somehow “prove” themselves. Involvement relies on complex social processes. This work supports the view that an improved understanding of how key processes are enabled, as well as what involvement achieves, is now needed.     

Use and Preference of Advice on Small Children's Food: Differences Between Parents From Ethnic Minority,Ethnic Majority,and Mixed Households

The authors analyzed the influence of acculturation on parental attitudes to, and use of, different sources of health advice about young children's food in Denmark. Using combined ethnic position of the children's parents as a proxy for household acculturation, the authors conducted a postal survey of 2,511 households with young children (6 months to 3.5 years) occupying ethnic minority, ethnic majority, or ethnic mixed position. The analysis showed that the use of advice differed in the 3 groups. Households with ethnic minority status were more likely to use the child's grandparents, general practitioners, and hospital staff as information sources, while households with ethnic majority status were more likely to use mothers’ peer groups and written material. In all types of household municipal public health nurses were relied on as a source of advice on young children's food, but households with ethnic minority status were more likely to find the advice obtained in this way incompatible with their family eating habits. Although existing dietary health communication strategies delivered by public health nurses appear to work well in all household types, parents from minority households seem to experience dilemmas. These may be related to their cultural and generational status at the time of receiving the advice. Adjustments to current communication strategies on young children's food are suggested.     

Prioritising home care needs: research with older people from three ethnic minority community groups

This paper draws on research with three minority ethnic community groups in Manchester. The aim of the study was to examine and prioritise social care needs. Focus groups were chosen as a way of beginning discussion about these issues. The findings suggest that some quality issues are relevant to all communities of older people. However, some were specific to the community groups. This paper describes some of the lessons learned about running focus groups with people whose first language is not English and suggests some considerations for future research.     

Children of parent(s) who have a gambling problem: a review of the literature and commentary on research approaches

Problem gambling is becoming an increasingly widespread and damaging social and health problem. As opportunities for gambling become more accessible, especially through lotteries and electronic gaming machines, it is likely that more people will develop serious gambling problems. Given the worldwide increasing spending on gambling activities and the increasing number of problem gamblers, it is unfortunate but likely that the children who grow up in problem gambling families will become an important area of concern for child health and social workers. Considerable research has been undertaken into problem gambling and the adult problem gambler, but within the gambling and child health literature there is almost no recognition of the experiences of children who live in problem-gambling families. Drawing on the findings of the landmark Productivity Commission Report, this review explores the marked increase in gambling and its social effects, especially from the Australian perspective. The damaging social effects of problem gambling on families and children are reviewed and the comparative invisibility of children and young people in such research is discussed. The pervasive influence of developmentalism is critiqued and highlighted in relation to the exclusion of children's perspectives from our research understandings. The review concludes by proposing that adoption of some of the emerging 'new paradigm' approaches to childhood and children's experiences could markedly enhance our understandings of the lives and experiences of this significant group of children and young people.     

Towards a Sociology of Child Health

This paper argues that children, as an important social group, repay study in connection with the sociology of health and illness. The paper outlines the neglect of children within medical sociology and goes on to open up a discussion towards a sociology of child health. The paper makes three main points. First, consideration of the case of health and illness helps understanding of children's social positioning as a minority group. Secondly, children present a clear case for considering people as embodied health care actors. Thirdly, taking account of children in the sociology of health requires rethinking the division of labour and inter-generational relationships within it.